STRATEGIES TO REDUCE EMERGENCY DEPARTMENT REPEAT VISITS AND STROKES ASSOCIATED WITH ATRIAL FIBRILLATION

Abstract

Atrial Fibrillation and Flutter are common medical complaints and lead to a significant burden on the Emergency Department (ED). We explored change in ED repeat visits following practice changes including the introduction of a nurse practitioner led AF telephone follow-up practice, for patients at high risk of ED repeat visit. A quantitative retrospective analysis of ED repeat presentations. A consecutive cohort study of ED repeat visit rates and hospital admissions associated with AF in patients presenting between 2015-2017 was quantitatively compared with a previously published cohort from 2010-2012. The study was conducted at geographically contained regional hospital emergency departments. A MUSE database of ED patients with confirmed ECG evidence of AF was matched with the National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database databases to collect 12-month ED and hospital encounter data. The primary measure was repeat visits to the ED. Between calendar years 2010-2012 and 2015-2017 the EDs experienced a 6.8% rise in overall presentations (277,853 to 296,852). The Muse database contained 1642 patients identified between 2015-2017. Over 12 months, 849 of these patients returned to the ED generating 1879 repeat visits. Mean time to repeat visit was 93.5±97.6 days. Twenty patients returned with a diagnosis of cerebral embolic event (20/1642 (1.2%)). Detailed data was collected on 319 selected patients in the telephone practice. 108 patients had a repeat visit (34%) at a mean of 96.8±94.0 days and generated a total of 215 repeat visits. Our 2015-2017 data compared very favorably with our initial published audit of 2010-2012 with significantly less ED repeat visits and cerebral embolic events. In addition, significantly less telephone practice patients returned to the ED compared with the contemporary 2015-2017 cohort (34% and 52%, respectively (p<0.001)). Conclusions: Atrial fibrillation represents a significant burden on health care resources, in particular the ED. Reduction in ED repeat visits were observed over a five year period. Telephone practice significantly reduces ED resource utilization.